When Satisfactory Biologics Are Not Enough: Satisfying Sex With Rheumatoid Arthritis

Health Professional

Autumn is here. Whether it is because we are cold, or we sense the never-ending cycle of life heading into its dormant period, it is not surprising we find ourselves reaching out toward that significant other. We hold that loved one and wish life to live forever in the moment of intimacy we have both found.

But what if that moment were to become a thing approached with apprehension?

Having rheumatoid arthritis can certainly impact sexuality and intimacy. At the 2006 European League Against Rheumatism meeting, a study was presented which concluded that nearly one-third of rheumatoid arthritis patients found their illness caused sexual difficulties. Many women with rheumatoid arthritis find that their partner tends to avoid sexual activity for fear of causing pain to their frail lover. The patients themselves may also suffer from reduced libido as a result of medications and/or the depression which naturally occurs when a person is afflicted with a chronic illness.

Pain itself can affect lubrication and sexual response in the female patient, and cause erectile dysfunction in the male patient. Joint pain obviously has an impact on certain sexual positions, as does muscle weakness and wasting. A patient's awareness of any joint deformity can cause interfering self-consciousness; this can lead to fear that one's partner will seek sexual gratification from a "non-ill" person, which also can affect libido. This is where love steps in and conquers all; without it, intimacy is difficult to establish even in well people.

The sexual act itself can be made a little more comfortable if pain medication is taken 30 to 60 minutes beforehand. As many rheumatoid arthritis patients feel worse in the morning, love in the afternoon might become the norm. Of course, if there is going to be the possibility of pain during lovemaking, where that pain is will depend on what joints are affected; this in turn will have an impact on the decisions regarding sexual position. There should be no shame as to sexual position. On the other hand, many couples experience great and mutual satisfaction through masturbation or oral sex; these activities can have great importance if the physical damage due to rheumatoid arthritis has left one of the partners less than satisfied.

The most comfortable position will be dictated by the most uncomfortable joints:
1. Painful upper extremities: If wrists are painful, lying on the back or side is best; although one could try making a fist and keeping the wrists in a neutral position. Elbows can be supported by strategically placing some soft cushions or pillows.
2. Neck involvement: Patients with rheumatoid arthritis are at risk for spinal cord injury at the level of the neck. For those who have been told by their rheumatologist that there is a neck problem, they should avoid placing pillows behind the neck. They should avoid bending the neck forward, particularly when having sex while on the back.

3. Hip pain: Moving the hips sideways and outwards may be restricted by pain or joint destruction. In those cases, it may be best that the male approach from behind with the female bending forward. An alternative position would be the male again approaching the female from behind, but this time both male and female would be lying on their sides.

4. Knee pain: Maintaining the knees in a straight position is best, and can be achieved with the woman leaning forward over the bed, allowing for the male to approach from behind; but a sideways approach, or a passive position with the partner on top might be better.

As with all things for all people, the state of mind must be in the best state possible. This applies to anything we human beings undertake in life, including making love. Of course, for the rheumatoid arthritis patient, the state of body is best optimized also.

Discuss the lovemaking with your lover. Work with your rheumatologist to treat the body.